Cixutumumab and Temsirolimus in Treating Patients With Locally Recurrent or Metastatic Breast Cancer

Phase 1

Completed

Conditions: Recurrent Breast Carcinoma
Stage IV Breast Cancer AJCC v6 and v7
Male Breast Carcinoma

Interventions: Biological: Cixutumumab
Other: Laboratory Biomarker Analysis
Other: Pharmacological Study
Drug: Temsirolimus

Registration Number: NCT00699491

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This phase I/II trial is studying the side effects and best dose of cixutumumab when given together with temsirolimus and to see how well they work in treating patients with breast cancer that has recurred (come back) at or near the same place as the original (primary) tumor or has spread to other places in the body. Monoclonal antibodies, such as cixutumumab, can block tumor growth in different ways by targeting certain cells. Temsirolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving cixutumumab together with temsirolimus may be a better treatment for breast cancer.

Detailed Description: PRIMARY OBJECTIVES:

I. To establish the recommended dose level for the phase II trial. (Phase I) II. To examine the safety profile of this combination in patients with metastatic breast cancer. (Phase I) III. To assess the anti-tumor activity (in terms of overall response rate) and toxicity profile of IMC-A12 (cixutumumab) in combination with temsirolimus in patients with metastatic breast cancer. (Phase II)

SECONDARY OBJECTIVES:

I. To estimate the progression-free survival (PFS) and overall survival distributions (as well as the 6-month PFS rate).

II. To evaluate the in vivo mechanisms of action of temsirolimus in combination with IMC-A12 and to examine potential biomarker predictors of treatment response.

OUTLINE: This is a phase I, dose-escalation study of cixutumumab followed by a phase II study.

Patients receive temsirolimus intravenously (IV) over 30 minutes and cixutumumab IV over 60 minutes on days 1, 8, 15, and 22 (cixutumumab is given on days 8, 15, and 22 of course 1 only). Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up periodically for up to 2 (phase I) or 5 (phase II) years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 48

Inclusion Criteria

Histologically confirmed diagnosis of breast cancer with diagnosis of metastatic or locally recurrent disease (locally recurrent disease should be stage IV e.g. chest wall involvement)
Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1 (Karnofsky >= 80%)
Life expectancy of > 12 weeks
Capable of understanding investigational nature, potential risks and benefits of the study and able to provide written informed consent
Negative serum pregnancy test =< 7 days of registration for women of childbearing potential:
- Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) for the duration of study therapy and for 3 months after the last dose of IMC-A12 and CCI-779 (temsirolimus)
- Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
- Nursing women must be willing to discontinue nursing; NOTE: breastfeeding should be discontinued if the mother is treated with CCI-779 and IMC-A12
Absolute neutrophil count >= 1,500/mcL
Hemoglobin >= 8.5 g/dL
Platelets >= 100,000/mcL
Total bilirubin =< 1.5 X institutional upper limit of normal (ULN)
Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT)(serum glutamate pyruvate transaminase [SGPT]) =< 3 x institutional ULN (=< 5 X institutional ULN if liver function test [LFT] elevations due to liver metastases)
Creatinine =< 1.5 X institutional ULN OR creatinine clearance >= 60 mL/min/1.73^2 for patients with creatinine > institutional ULN
Fasting serum cholesterol =< 350 mg/dL (9.0 mmol/L)
Fasting triglycerides =< 400 mg/dL (4.56 mmol/L)
Albumin >= 3.4 mg/dL
Fasting or non fasting serum glucose < 120 mg/dL
Hemoglobin A1c (HbA1c) (for all patients with a history of diabetes mellitus) < 8%
Phase I only: Any number of prior therapy regimens is allowed
Phase II only: Measurable disease is required for the Phase II portion of the study; measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 20 mm with conventional techniques (computed tomography [CT], magnetic resonance imaging [MRI], x-ray) or as >= 10 mm with spiral CT scan
Phase II only: =< two and at least one prior chemotherapy regimens in the setting of metastatic or locally recurrent (stage IV chest wall involvement) disease are required

Exclusion Criteria

Phase I patients only: Patients with base line diabetes requiring oral hypoglycemics or insulin
Phase II patients only: Poorly controlled diabetes mellitus; NOTE: patients with a history of diabetes mellitus on oral hypoglycemics or insulin are allowed to participate, provided that their fasting blood glucose is < 120 mg/dL and that they are on a stable dietary or therapeutic regimen for this condition
Any of the following:
- Pregnant women
- Nursing women
- Men or women of childbearing potential who are unwilling to employ adequate contraception (hormonal agents are not allowed and oral contraceptives are not acceptable for contraception)
Receiving hormonal agents used for the treatment of breast cancer with the exception that premenopausal women who have been on a gonadotropin-releasing hormone (GnRH) agonist and subsequently progressed may, at the discretion of the treating physician, continue on the GnRH agonist
Any of the following prior therapies:
- Systemic anti-cancer therapy =< 3 weeks prior to registration
- Radiation therapy =< 2 weeks prior to registration
Prior invasive non-breast malignancy, except for adequately treated basal or squamous cell carcinoma of the skin or other cancer from which the patient has been disease free for >= 5 years
Known hypersensitivity reactions to macrolide antibiotics (such as erythromycin, clarithromycin, and azithromycin); allergic reactions attributed to compounds of similar chemical or biologic composition to IMC-A12, or temsirolimus
Prior treatment with agents targeting the insulin-like growth factor-I receptor (IGF-IR)/insulin-like growth factors (IGFs) or phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha (PI3K)/v-akt murine thymoma viral oncogene homolog 1 (Akt)/mechanistic target of rapamycin (mTOR) pathway
Receiving any other investigational agents or herbal preparations
Patients may not be taking oral corticosteroids except for replacement for adrenal insufficiency
Uncontrolled brain metastases; Note: brain metastases are not permitted on study unless the metastases have been treated by surgery or radiotherapy, and the patient has been neurologically stable and off of steroids for >= 12 weeks
Known human immunodeficiency virus (HIV)-positive patients who have cluster of differentiation (CD)4 counts below the normal range or who are on anti-retroviral therapy that may interfere with the metabolism of temsirolimus
Uncontrolled intercurrent illness including, but not limited to:
- Ongoing or active infection
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Uncontrolled symptomatic cardiac arrhythmia
- Psychiatric illness/social situations that would limit compliance with study requirements
Receiving enzyme-inducing antiepileptic drugs (EIAEDs; e.g., phenytoin, carbamazepine, phenobarbital) or any other cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) inducer such as rifampin or St. John's wort

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Treatment (cixutumumab, temsirolimus)	Cixutumumab	Patients receive temsirolimus IV over 30 minutes and cixutumumab IV over 60 minutes on days 1, 8, 15, and 22 (cixutumumab is given on days 8, 15, and 22 of course 1 only). Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Treatment (cixutumumab, temsirolimus)	Laboratory Biomarker Analysis	Patients receive temsirolimus IV over 30 minutes and cixutumumab IV over 60 minutes on days 1, 8, 15, and 22 (cixutumumab is given on days 8, 15, and 22 of course 1 only). Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Treatment (cixutumumab, temsirolimus)	Pharmacological Study	Patients receive temsirolimus IV over 30 minutes and cixutumumab IV over 60 minutes on days 1, 8, 15, and 22 (cixutumumab is given on days 8, 15, and 22 of course 1 only). Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Treatment (cixutumumab, temsirolimus)	Temsirolimus	Patients receive temsirolimus IV over 30 minutes and cixutumumab IV over 60 minutes on days 1, 8, 15, and 22 (cixutumumab is given on days 8, 15, and 22 of course 1 only). Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Recommended Dose Level for Phase II Testing (RPTD) (Phase I)	During first course	The RPTD is defined as the highest dose level at which at most one of 6 patients develops a dose limiting toxicity (DLT) during the first course of treatment and the next highest dose level has 2 or more DLTs. The number of patients in each cohort reporting a DLT is reported. Dose-limiting toxicities (DLTs) are defined as any of the following adverse events (AEs) that are related to study agent with an attribution of possible, probably, or definite and fulfilling one of the following criteria: * Any grade 4 hematologic toxicity * Hyperglycemia that cannot be stably controlled with diabetic medication * Any grade 3 or 4 non-hematologic toxicity (except asymptomatic medically manageable laboratory abnormalities such as hyperlipidemia, hypophosphatemia, and hypokalemia)
Tumor Response Rate (TRR) (Complete Response [CR] or Partial Response [PR]) by the Response Evaluation Criteria in Solid Tumors (RECIST) (Phase II)	Up to 5 years	A response is defined as a disease burden that meets the RECIST criteria for Complete Response (CR) or Partial Response (PR) on 2 consecutive evaluations at least 6-8 weeks apart. Complete Response (CR): All of the following must be true: 1. Disappearance of all target and non-target lesions. 2. Each target lymph node must have reduction in short axis to \<1.0 cm. Partial Response (PR): At least a 30% decrease in PBSD (sum of the longest diameter for all target lesions plus the sum of the short axis of all the target lymph nodes at current evaluation) taking as reference the baseline measures. The rate is calculated by dividing the number of patients with a CR or PR by the number of evaluable patients. A ninety percent confidence interval for the true tumor response rate will be calculated using the Duffy-Santer approach.

Secondary Outcome Measures

Name	Time	Method
Progression Free Survival (PFS) (Phase II)	Time from registration to documentation of disease progression, up to 5 years	Progression free survival is defined as the time from registration to documentation of disease progression. If a patient dies without a documentation of disease progression, the patient will be considered to have had tumor progression at the time of their death unless there is sufficient documented evidence to conclude no progression occurred prior to death. If the patient is declared to be a major treatment violation, the patient will be censored on the date the treatment violation was declared to have occurred. In the case of a patient starting treatment and then never returning for any evaluations, the patient will be censored for progression on the last day of therapy was administered. The distribution of progression-free survival times will be estimated using the Kaplan-Meier method.The distribution of PFS times will be estimated using the Kaplan-Meier method.
Progression Free Survival Rate	At 6 months	Progression free survival (PFS) is defined as the time from registration to documentation of disease progression. A point and interval estimate of the 6 month PFS rate will be obtained using the Kaplan-Meier method.
Adverse Events Graded Using the NCI CTCAE Version. 3 (Phase II)	Up to 5 years	Adverse events will be graded using the NCI-CTCAE v3.0 coding scheme. The maximum grade for each adverse event considered to be 'at least possibly related to treatment' will be recorded. Frequency tables will be constructed and the number of patients reporting an adverse event of grade 3 or higher at least possibly related to treatment will be reported.
Duration of Response (Phase II)	Up to 5 years	Duration of response is defined for all evaluable patients with changes in disease burden that met the RECIST criteria for CR or PR on 2 consecutive evaluations at least 6-8 weeks apart as the date at which the CR or PR to the date progression is documented. The distribution of response durations will be estimated using the Kaplan-Meier method.
Survival Time (Phase II)	Time from registration to death due to any cause	Survival time is defined as the time from registration to death due to any cause. The distribution of survival time will be estimated using the method of Kaplan-Meier.

Trial Locations

Locations (192): University of Chicago Comprehensive Cancer Center
🇺🇸
Chicago, Illinois, United States
Methodist Medical Center of Illinois
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Peoria, Illinois, United States
Columbus NCI Community Oncology Research Program
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Columbus, Ohio, United States
Doctors Hospital
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Columbus, Ohio, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Memorial Hospital
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Carthage, Illinois, United States
Eureka Hospital
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Eureka, Illinois, United States
Saint Cloud Hospital
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Saint Cloud, Minnesota, United States
Green Bay Oncology - Oconto Falls
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Oconto Falls, Wisconsin, United States
Cone Health Cancer Center
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Greensboro, North Carolina, United States
Fredericksburg Oncology Inc
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Fredericksburg, Virginia, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
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Maumee, Ohio, United States
Cooper Hospital University Medical Center
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Camden, New Jersey, United States
Franciscan Health Indianapolis
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Indianapolis, Indiana, United States
Graham Hospital Association
🇺🇸
Canton, Illinois, United States
Illinois CancerCare-Bloomington
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Bloomington, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
Community Cancer Center Foundation
🇺🇸
Normal, Illinois, United States
Illinois CancerCare-Community Cancer Center
🇺🇸
Normal, Illinois, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸
Ottawa, Illinois, United States
Illinois CancerCare-Monmouth
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Monmouth, Illinois, United States
Mount Carmel Health Center West
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Columbus, Ohio, United States
Penrose-Saint Francis Healthcare
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Colorado Springs, Colorado, United States
Boulder Community Hospital
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Boulder, Colorado, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Saint Mary Corwin Medical Center
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Pueblo, Colorado, United States
Altru Cancer Center
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Grand Forks, North Dakota, United States
Saint Anthony Hospital
🇺🇸
Lakewood, Colorado, United States
Menorah Medical Center
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Overland Park, Kansas, United States
SCL Health Lutheran Medical Center
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Wheat Ridge, Colorado, United States
Longmont United Hospital
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Longmont, Colorado, United States
Coborn Cancer Center at Saint Cloud Hospital
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Saint Cloud, Minnesota, United States
Essentia Health Saint Mary's Medical Center
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Duluth, Minnesota, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸
Lihue, Hawaii, United States
Hawaii Oncology Inc-Pali Momi
🇺🇸
'Aiea, Hawaii, United States
Pali Momi Medical Center
🇺🇸
'Aiea, Hawaii, United States
Saint Luke's South Hospital
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Overland Park, Kansas, United States
Essentia Health Cancer Center
🇺🇸
Duluth, Minnesota, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Kansas City NCI Community Oncology Research Program
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Prairie Village, Kansas, United States
Castle Medical Center
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Kailua, Hawaii, United States
Saint Alexius Medical Center
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Bismarck, North Dakota, United States
Mid Dakota Clinic
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Bismarck, North Dakota, United States
Sanford Bismarck Medical Center
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Bismarck, North Dakota, United States
The Medical Center of Aurora
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Aurora, Colorado, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
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Denver, Colorado, United States
SCL Health Saint Joseph Hospital
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Denver, Colorado, United States
Rose Medical Center
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Denver, Colorado, United States
Colorado Cancer Research Program NCORP
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Denver, Colorado, United States
Florida Hospital Orlando
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Orlando, Florida, United States
Michigan Cancer Research Consortium NCORP
🇺🇸
Ann Arbor, Michigan, United States
Saint Joseph Mercy Hospital
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Ann Arbor, Michigan, United States
Saint John Hospital and Medical Center
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Detroit, Michigan, United States
Mayo Clinic
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Rochester, Minnesota, United States
Alegent Health Immanuel Medical Center
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Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
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Omaha, Nebraska, United States
Alegent Health Lakeside Hospital
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Omaha, Nebraska, United States
Creighton University Medical Center
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Omaha, Nebraska, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Palo Alto Medical Foundation Health Care
🇺🇸
Palo Alto, California, United States
Valley Medical Oncology Consultants
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Pleasanton, California, United States
Swedish Medical Center
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Englewood, Colorado, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸
Hartford, Connecticut, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
John B Amos Cancer Center
🇺🇸
Columbus, Georgia, United States
Saint Alphonsus Cancer Care Center-Boise
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Boise, Idaho, United States
Saint Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
Weiss Memorial Hospital
🇺🇸
Chicago, Illinois, United States
Heartland Cancer Research NCORP
🇺🇸
Decatur, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Illinois CancerCare-Havana
🇺🇸
Havana, Illinois, United States
Ingalls Memorial Hospital
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Harvey, Illinois, United States
Mason District Hospital
🇺🇸
Havana, Illinois, United States
Mcdonough District Hospital
🇺🇸
Macomb, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
Holy Family Medical Center
🇺🇸
Monmouth, Illinois, United States
Bromenn Regional Medical Center
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Normal, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Illinois CancerCare-Pekin
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Pekin, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
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Pekin, Illinois, United States
Illinois CancerCare-Peoria
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Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Illinois Valley Hospital
🇺🇸
Peru, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Perry Memorial Hospital
🇺🇸
Princeton, Illinois, United States
Illinois CancerCare-Spring Valley
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Spring Valley, Illinois, United States
Siouxland Regional Cancer Center
🇺🇸
Sioux City, Iowa, United States
Reid Health
🇺🇸
Richmond, Indiana, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Union Hospital of Cecil County
🇺🇸
Elkton, Maryland, United States
Bixby Medical Center
🇺🇸
Adrian, Michigan, United States
Hickman Cancer Center
🇺🇸
Adrian, Michigan, United States
Beaumont Hospital-Dearborn
🇺🇸
Dearborn, Michigan, United States
Green Bay Oncology - Escanaba
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Escanaba, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸
Flint, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Green Bay Oncology - Iron Mountain
🇺🇸
Iron Mountain, Michigan, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
Mercy Memorial Hospital
🇺🇸
Monroe, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Lake Huron Medical Center
🇺🇸
Port Huron, Michigan, United States
Toledo Clinic Cancer Centers-Monroe
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Monroe, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Saint Mary's of Michigan
🇺🇸
Saginaw, Michigan, United States
Saint Joseph Oncology Inc
🇺🇸
Saint Joseph, Missouri, United States
Saint Luke's East - Lee's Summit
🇺🇸
Lee's Summit, Missouri, United States
Missouri Valley Cancer Consortium
🇺🇸
Omaha, Nebraska, United States
Glens Falls Hospital
🇺🇸
Glens Falls, New York, United States
Randolph Hospital
🇺🇸
Asheboro, North Carolina, United States
Wayne Memorial Hospital
🇺🇸
Goldsboro, North Carolina, United States
Annie Penn Memorial Hospital
🇺🇸
Reidsville, North Carolina, United States
Margaret R Pardee Memorial Hospital
🇺🇸
Hendersonville, North Carolina, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸
Bowling Green, Ohio, United States
Grant Medical Center
🇺🇸
Columbus, Ohio, United States
Blanchard Valley Hospital
🇺🇸
Findlay, Ohio, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Hematology Oncology Center Incorporated
🇺🇸
Elyria, Ohio, United States
Mercy Cancer Center-Elyria
🇺🇸
Elyria, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸
Maumee, Ohio, United States
Knox Community Hospital
🇺🇸
Mount Vernon, Ohio, United States
Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Springfield Regional Medical Center
🇺🇸
Springfield, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
Flower Hospital
🇺🇸
Sylvania, Ohio, United States
Saint Charles Hospital
🇺🇸
Oregon, Ohio, United States
Southern Ohio Medical Center
🇺🇸
Portsmouth, Ohio, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸
Oregon, Ohio, United States
Saint Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
The Toledo Hospital/Toledo Children's Hospital
🇺🇸
Toledo, Ohio, United States
University of Toledo
🇺🇸
Toledo, Ohio, United States
Mercy Saint Anne Hospital
🇺🇸
Toledo, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸
Toledo, Ohio, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸
Toledo, Ohio, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Fulton County Health Center
🇺🇸
Wauseon, Ohio, United States
Saint Ann's Hospital
🇺🇸
Westerville, Ohio, United States
Legacy Mount Hood Medical Center
🇺🇸
Gresham, Oregon, United States
Legacy Good Samaritan Hospital and Medical Center
🇺🇸
Portland, Oregon, United States
Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
Natalie Warren Bryant Cancer Center at Saint Francis
🇺🇸
Tulsa, Oklahoma, United States
Legacy Meridian Park Hospital
🇺🇸
Tualatin, Oregon, United States
Legacy Salmon Creek Hospital
🇺🇸
Vancouver, Washington, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸
Green Bay, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸
La Crosse, Wisconsin, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary's
🇺🇸
Green Bay, Wisconsin, United States
Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸
Manitowoc, Wisconsin, United States
Green Bay Oncology - Sturgeon Bay
🇺🇸
Sturgeon Bay, Wisconsin, United States
HSHS Saint Nicholas Hospital
🇺🇸
Sheboygan, Wisconsin, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸
Flint, Michigan, United States
Mercy Medical Center-Sioux City
🇺🇸
Sioux City, Iowa, United States
Saint Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Sparrow Hospital
🇺🇸
Lansing, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸
Warren, Michigan, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Nebraska Cancer Research Center
🇺🇸
Lincoln, Nebraska, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸
Green Bay, Wisconsin, United States
Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸
Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸
Honolulu, Hawaii, United States
Hawaii Cancer Care Inc-POB II
🇺🇸
Honolulu, Hawaii, United States
Hawaii Oncology Inc-Kuakini
🇺🇸
Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸
Honolulu, Hawaii, United States
Saint Luke's Hospital of Kansas City
🇺🇸
Kansas City, Missouri, United States
North Kansas City Hospital
🇺🇸
Kansas City, Missouri, United States
Heartland Hematology and Oncology Associates Incorporated
🇺🇸
Kansas City, Missouri, United States
Research Medical Center
🇺🇸
Kansas City, Missouri, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Samaritan North Health Center
🇺🇸
Dayton, Ohio, United States
Dayton NCI Community Oncology Research Program
🇺🇸
Dayton, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸
Zanesville, Ohio, United States